re: Testosterone-replacement therapy does not increase cardiac events in men

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I'm aware. I was replying to someone else just reporting another difference between the mode of treatment.

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Yes, the difference between IM and other methods is well documented. Stan Effering has a good YouTube video about it. Maybe I did not word my point well. While not a direct heart correlation, IM DOES cause sides like increased HMG/HCT that can impact the heart, strokes, etc. How clinically significant that is is up for debate. I think Stan quotes 67% of IM users having this side vs. 16% of gel users. He goes on to say that there is a difference between erythrocytosis/increased RBC and polycythemia/blood thickening.

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wonder about the psychological effects.

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there aren't psychological effects. You arent getting your levels supra-max

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Feeling physically as I did in my twenties (better yet, how I could have felt if I had worked out then) sounds great, but acting/emoting/thinking etc as I did then does not appeal to me.

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as mentioned you shouldnt be. for 1 you shouldnt have levels of a 18-21 year old at 40 even when on trt. You can if you choose but i personally think you should have upper ranges for your age. some like to say you should keep it to 1000 ng/dl and that is fine if you show no signs but i personally think it should be based on age for the most part

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Doesn’t matter anyway, if it shuts down natural test production, I don’t see myself ever choosing it.

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well you should only get on trt if you dont produce much naturally. Anytime you take an exogenesis hormone you are going to get a negative feedback loop that shuts down natural production. on trt this doesnt matter because you have made the decision to go on for a lifetime due to your body not producing much if at all naturally and certainly not for your age.


guess im confused on why you would care if natural production is shut down if you arent making much to begin with and are making the decision to go on for life

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Based on my own fairly naturalistic worldview, specifically that I think the natural reduction of test production with aging (beyond mid-life, especially) may be beneficial in allowing us to age well. “Age well” is up for interpretation but for me it includes growing in wisdom, the kind of wisdom that may only accrue with the reduction of testosterone. Also, not really wanting to look at pictures of naked chicks would be a feature of aging well.

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yea frick all that

testosterone plays a big part in mental health btw and huge part of quality of life.

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What are the side effects of getting off TRT after let's say...a year?

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you will need to do a full post cycle therapy and lets be clear going on trt for a year is just stupid. if you are going to shut down natural test, just do a cycle of 300-400mg min for 6 months.

atleast make it worth it. 120-150mg a week isnt going to give you any performance benefit unless you are already extremely low.

so side effects would be

- very low testosterone when you come off. you may be able to restart hpta axis and get back up to previous levels, maybe not.

- during the time you have the extreme low test you will have the symptoms of that

-it will effect sperm quality and quantity and you may not recover from this

its the same as coming off a steroid cycle

pct would need to be pretty inclusive

-2 different serms
- high doses of hcg
- if possible hmg


trt is a lifetime decision, coming on and off is not trt. What is your reason for asking?

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yea frick all that

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100% agree with you 777!

I feel great on it. My wife gets annoyed at times, but she goes with the flow.

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Today was the first day of doing squats and holy hell my legs/hamstrings are on fire.

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Just wait until to have to sit down to shite tomorrow.

Wish my doctor would read this board. Dude says 350 is a perfectly fine level, and this aint an OT joke.

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I don’t know exactly what you’re getting at, but I do wonder about the psychological effects.

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It changed my personality a bit. For the better mostly though. I just didn't put up with as much shite from people once I started it. Been on trt about 3 years now.

This is a topic that gets my pisstivity levels sky high. Been trying to educate people about this topic for a long time. You'd be amazed at the number of clinicians who were told long ago about negative effects, have never looked at literature since their training, and go on to teach others the same thing.

There was a paper that came out in 2013 in JAMA that did immense damage to TRT. Lead author Vigen. It's the worst and most irresponsible statistical analysis I've ever seen in such a contentious subject. Claimed increased cardiovascular risk. I think it's very likely the true result was in the opposite direction. Paper should have been retracted but journals never want to go down that road.

They used stabilized weights in an extended Kaplan Meier survival analysis, and with messy data the test statistic behaves in a wildly erratic manner. This always produces messy data. Simulations have demonstrated this. Not only this, but they had a very high amount of misclassification, which plays into the messy data.

I mean this honestly, I think I know more about that analysis than anyone else in the world. It's just awful. Additionally, the data generating mechanism is a change state model, which is intractable mathematically. They tried Kaplan Meier but that was the wrong choice, then used stabilized weights which was insane - the whole thing was a disaster - yet the FDA cited it prominently in its decision to issue a warning about TRT.

I worked in research at the VA and published on this topic. I also looked at VA data and found that as time went on, people were spending more and more time off of their TRT, when looking at their prescription data, so compliance was spotty at best and had significant gaps between prescriptions when their levels were clearly going to be very low.

I tried to draw attention to this while working at the VA - I got the data, did the analysis, pointed out some flaws with Vigen and other papers, and called for a re-look at a lot of TRT data and a better understanding of the stats being used, the nature of TRT usage etc. Very simple paper. Contacted Annals of Internal Medicine (very prestigious journal) and asked for expedited review due to the nature of this topic, they agreed. Got rejected because they thought the paper was sloppy because citation information wasn't complete for a couple references. It wasn't complete because when the paper was written the citation information had not been completed by the publisher - these studies were brand new and journals put them on PubMed without knowing which volume and page they would end up on. By the time the papers got to a reviewer that info had been updated and the reviewers didn't bother to connect the dots on this. I'm still chapped about this.

The statistical analysis for these types of papers is very sophisticated and there are too many people winging it just because the computing power is available. I contacted another journal a guy had just started, devoted specifically to these analytical issues. I asked the editor if he was interested and he said yes. One of the journal editors was part of the team that put out one of the modeling procedures for these types of analyses and I specifically wanted his commentary. I also met with a lady at UF who was part of that team - she was unbelievably rude and dismissive. Harvard person. That journal required a certain software be used for manuscript generation. I put in a request with the VA to have installed on my computer - the funding for my position expired before I ever heard from the VA, so that never happened.

There was heavily flawed research in the early days about testosterone and it got the bad rep of being related to prostate cancer and CVD. If you go to PubMed and look for an author, Morgentaler, lot of free articles you can get with him - he has written about this, the history etc.

Injection produces an early peak then a gradual decline in levels. Pretty potent stimulator of blood cell production, which is why doctors like to look at things like hematocrit when you're on TRT. Transdermal (gel) TRT isn't as pronounced at blood cell production, but the enzyme that converts T to DHT is present in higher amounts in the skin so you will get more conversion to DHT, which has aroused some debate over the years. Transdermal is not going to produce the peaks and valleys like injection, but it's daily, not weekly or bi-weekly.

This graph is pretty good. Note with injection on a typical schedule, that the person will be back to baseline and a low T level for some time prior to another injection, and right after the injection a person can zoom into supraphysiological levels. Gel presents its own problems though, like needing to avoid skin to skin contact, more DHT production etc.


There are some differences between the two routes, but not like night & day such that your entire outlook or physiological profile will change.
Injection may be safer
Elevation of DHT and CV risks vary by route
T deficiency historical perspective

Edit - on that graph, the same phenomena is seen whether your injections are weekly, bi weekly, monthly etc. Typically you see 100mg/wk or 200mg/bi-weekly and so forth. Data I've seen is overwhelmingly a 200mg/bi-weekly approach. Generally what you see is this: shorter injection interval means less time back at/below baseline prior to next injection and less of a peak, while longer interval will be a larger peak and longer number of days at/below baseline prior to the next injection. Holy grail might be oral TRT, but prior formulations were toxic to the liver, but I believe they are still working on this. One of the uses for T is male contraception, but even when they've given guys 250mg/wk they still see some residual sperm production, so I don't think they've cracked the code on that - it's noteworthy that in such studies they rarely saw deleterious effects such that guys discontinued.

Also, for the people you encounter that think TRT is so much of a risk, I always point out that epidemiological studies of older eastern bloc athletes that were on the juice, showed no health effects and that we never see alarming levels of prostate cancer in powerlifters, strong men and others that we know to be on high doses, chronically. And in old school bodybuilders, they were not pitching clots and dying young like we see today, where guys are on a huge cocktail of stuff at insane levels.

Lastly, in a large VA study of prostate cancer where they blocked T production, within six months guys had severe health problems from depression to diabetes to occult cardiovascular disease. Adequate T is absolutely essential for men.

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You aren't the only one. I pay $300 a month at a clinic for test plus hcg. It is fricking insanely expensive and I really do not want to pay it. The amount of help it has been for the past 3-4 weeks though has been profound. I may have found a doctor, but no idea how she will react. I'm on my 3rd doctor...no one wants to help when my range was 311-330.

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Where are you located?

My doc checks my labs once per year. It's about $100 for that visit then he does a 6 month video checkup before renewing my prescription, that's my copay. Test would be $80 a vial from Amazon pharmacy but insurance covers it. It's $10 every 14 weeks. Even if I didn't have insurance I'd be wayyyyy under the $300 a month. I was a little lower than you but not much.